UK: UK Government Publishes White Paper on Public Health

Last Updated: 21 June 2005
Article by Pamela Buxton

Originally published March 2005

On 16 November 2004, the UK Government published its long awaited White Paper on Public Health (called Choosing Health: Making Healthy Choices Easier). It outlines a raft of measures aimed at improving public health in the UK.

CORE PRINCIPLES

The White Paper establishes three core principles of the new public health approach:

(a) Informed choice

The White Paper states that the public wants to be able to make its own decisions about choices that impact on people's health. The public expects the Government to support by helping to create the right environment. However, the Government considers there to be two important qualifications to the "free choice" perspective:

(i) we need special responsibility in relation to children who are too young to make informed decisions themselves, and

(ii) special arrangements need to be in place where one person's choice may cause harm or nuisance to another (the White Paper uses the example of second-hand smoke).

(b) Personalisation

The Government acknowledges that the support that some parts of the public need are not the same as those in another part of the public. For example, more deprived areas may need support that is more tailored to the realities of their individual lives, with support that is "personalised sensitively".

(c) Working together

The Government acknowledges that people need help to get healthier, and that "real progress depends on effective partnerships across communities", including local government, the NHS, advertisers, retailers, the media and so on. The Government considers its role to be to lead, co-ordinate and promote such partnerships.

PRIORITIES

The White Paper establishes the Government's six priorities in relation to health.

(a) Reducing the number of people who smoke, because:

(i) it can lead to various fatal diseases

(ii) people feel that they need support to address the problem

(iii) people are concerned about the effects of second hand smoke

(iv) parents are concerned about their children taking up smoking.

(b) Reducing obesity and improving diet and nutrition, because:

(i) there has been a rapid increase in obesity in both adults and children over the past decade

(ii) effective action now could help tackle related diseases (such as heart disease, cancer, stroke, high blood pressure etc).

(c) Increasing exercise, because it reduces the risk of major chronic diseases and premature death, and that a third of people are not active enough to benefit their health.

(d) Encouraging and supporting sensible drinking, because:

(i) alcohol misuse is linked to deaths from stroke, cancer, liver disease, injury and suicide

(ii) it places a burden on the NHS

(iii) it can be linked to absenteeism, domestic violence and violent crime.

(e) Improving sexual health, because:

(i) risk-taking sexual behaviour is increasing

(ii) diagnoses of sexually transmitted diseases from HIV to Chlamydia have increased in recent years

(iii) delays in diagnoses and treatment could lead to more people being infected.

(f) Improving mental health, because

(i) mental well-being is crucial to good physical health and making healthy choices

(ii) because stress is the most common reported cause of sickness absence

(iii) mental health can lead to suicide.

THE GOVERNMENT'S PLANS FOR ACTION

(a) Smoking

(i) The plans

The Government plans to ban smoking in all enclosed public places and workplaces by the end of 2008. In addition, all restaurants and bars that prepare and serve food will be smoke-free, but this will not extend to other pubs and bars, which will be free to choose whether to ban smoking or not. The restrictions on advertising of tobacco will be tightened further, and the Government proposes to consult on how to use picture warnings on tobacco products most effectively. The Government also wishes to place more emphasis on helping smokers to quit, from phone to text message support schemes.

(ii) The response

Neither side of the smoking debate appears to be happy with the Government's proposals. Prof Alex Markham, chief executive of Cancer Research UK, described the proposals as a "huge missed opportunity … The government has failed in its fundamental duty to protect our citizens' health and safety by opting out of a total ban on smoking in public places". The chairman of the British Medical Association, James Johnson, said he was concerned that pubs would find loopholes in the law, for example by ceasing their sale of food.

Conversely, Tim Lord, Chief Executive of the Tobacco Manufacturers' Association, considered the ban to go "beyond what the public has said it wants". Simon Clark, a director of Forest (Freedom Organisation for the Right to Enjoy Smoking Tobacco) said most people would be happy with more no-smoking areas, but a ban was a "systematic attempt to demonise smokers". It appears that the Government is going to face pressure from both sides of the smoking debate to push the level of any proposed ban their way, and the middle ground seems to have a distinct danger of not pleasing anyone.

(b) Obesity, diet and exercise

(i) The plans

The Government has stated its aim that, by mid- 2005, processed foods will be clearly labelled to indicate fat, sugar and salt content for shoppers in a hurry. The Food Standards Agency has been looking into this area in detail over the past couple of years, and it is also being investigated by the EU. It seems likely that some form of "signposting" scheme will be brought in later this year, but the exact nature of how this will be done is yet to be finalised. Further, Ofcom is studying how foods are advertised to children, with a view to voluntary restrictions on "junk food" adverts. The Government has stated that it plans to bring in legislation in 2007 if the voluntary restrictions fall short of what the Government requires. Emphasis is also being placed on schools to provide healthier meals and more fresh fruit and vegetables, and a large amount of money will be invested in school sport and the promotion of exercise generally.

(ii) The response

Food coding system: the National Consumer Council has endorsed a traffic light scheme, and the BMA has said that it is "pleased by the commitment to improve food labelling. The proposed traffic light system is a good starting point on which to build". There is possibility that the industry will be less keen, especially in a simplified "traffic light" where green means "eat plenty" and red means "eat sparingly", as certain foods may fall close to the line, and significant sales may be lost if a product falls just short of so-called "healthy levels" or is healthy in some ways (low in salt) but not in others (high in sugar).

Junk food advertising: health organisations appear to welcome the ban, with the BMA describing it as a "bold initiative". It remains to be seen how such legislation would work in practice if, indeed, it is even deemed necessary. The White Paper will probably be seen largely as setting a marker down to the industry. Industry may have concerns that such a marker is the beginning of a slippery slope whereby their products will be treated the same as alcohol and smoking are at the moment - and this is something that it will be keen to avoid.

(c) Alcohol

(i) The plans

Ofcom has strengthened rules of broadcast advertising of alcohol, in particular those adverts aimed at underage drinkers. The new rules came into effect on 1 January 2005, but there is a grace period that runs to September 2005 to allow those adverts already prepared to be shown this summer. Ofcom has delegated the difficult task of preparing guidance notes to the rules to the Advertising Standards Authority, which hopes to have some finalised notes in place by spring 2005. The Industry may have concerns that such rules are the first signs of an eventual ban on alcohol advertising, although no mention of this was made by the Government.

Alcohol manufacturers have been urged to include warnings to encourage sensible drinking on products and in advertising, but no such warnings are obligatory. The industry appears to be on a warning to put its house in order, before the Government does it for them.

(ii) The response

Many people are displeased that alcohol has, in their opinion, been given a relatively low profile in the White Paper. The Royal College of Physicians has blamed the Government for missing an opportunity to tackle alcohol misuse, and it feels that the Ofcom regulations "do not go nearly far enough in limitations on broadcast advertising of alcohol". The BMA has called for a complete ban on alcohol advertising.

(d) Sexual and mental health

(i) The plans

Sexual health: the Government plans a new national campaign targeted at those most at risk of catching an STD, or having an unplanned pregnancy. By 2008, the Government hopes that everyone referred to a Genito Urinary Medicine Clinic will have an appointment with 48 hours, and that Chlamydia screening will be rolled out across England by 2007.

Mental health: The Government wishes to tackle inequalities experienced by people from black and minority ethnic communities in their access to mental health care services. A further proposal is to put measures in place, under the Sure Start programme, to ensure young people are set on the "right path in life to protect against later mental health problems".

(ii) The response

Sexual health: many seem to welcome the Government's plans in this area, but some, including the National AIDS Trust, think that it falls short of aiding those with specific needs.

Mental health: again, some have welcomed the plans, including the Mental Health Foundation, which described the White Paper as a "new beginning", whilst others, including the charity Sane, are "disappointed that the government should choose targets which … do not recognise the urgent needs of the thousands of people with mental illness now".

SUMMARY

The White Paper is very general in a number of areas, making broad statements about how things should be dealt with, but deferring actually dealing with them until later. Where the Government does make concrete proposals, supporters of such plans often appear to consider them to be lacking in many areas whilst opponents argue that they take away choice from consumers (for example, by imposing broad bans on smoking in enclosed public spaces). The cautious approach of the Government may be welcomed by some, as it could be seen to demonstrate the Government's willingness to draw the right line between sufficient regulation and over-regulation.

Much of the White Paper summarises existing proposals, such as the food labelling "signposting", and focuses them into one document. The broad intention is to make the nation healthier, but the Government will need to be careful to ensure that it is done fairly; for example, without unreasonably restricting the market's ability to advertise any products which could be "bad" for people (as the Government is signalling an intention to place significant restrictions on alcohol and "junk food" advertising in the future). The Government may face significant opposition if it eventually takes the line that, in order to make the public healthier, a series of bans on advertising are necessary in the same way that they have been imposed on the tobacco industry.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

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